many more tissue donors available than organ donors; less time critical; early notification allows collection of blood specimens for nucleic acid testing and screening for viral infections; more exclusion criteria (may require full post-mortem to exclude CJD)
Palliative care is distinct from curative care, which is primarily disease-specific and focused on restoration of health; Palliative care is not synonymous with end of life care, but is an important part of end of life care; As 10-20% of ICU patients will die, the transition from cure to comfort is a common and important decision to make
Medical Management of Potential Donors
The End-of-Life Care Family Meeting is a core component of ICU care; Evidence suggests that communication with families is often inadequate; The principles apply to end-of-life discussions in other settings (e.g. ED) as well
Donation after Circulatory Death (DCD) refers to organ donation taking place once circulatory arrest has occurred following treatment withdrawal
DBD = donation after brain death; DCD = donation after cardiac death; WIT = time from treatment withdrawal until cold perfusion (most important phase = when SBP < 60mmHg)
Coma-like Syndromes
Changes in Brain Death Consensus Statement (V3.2 2013)
Brain death is the irreversible loss of all functions of the brain, including the brainstem. The three essential findings in brain death are coma (unresponsiveness), absence of brainstem reflexes, and apnoea
To make the diagnosis of brain death the examiner must be able recognise responses that do not require brain function; stimulus-provoked movements should be termed reflexes and spontaneous movements termed automatisms; brain death-associated automatisms may be present in up to 50% of brain death cases
Acute Aortic Dissection: the most common catastrophe of the aorta (3:100,000); 3 times more common than abdominal aortic aneurysm (AAA) rupture
OVERVIEW Involves these steps: Early identification Establish rapport with family early Non-coercive discussion with family regarding opportunity to donate Initiate tissue typing, organ function testing and viral screening Maintain extra-cerebral physiological stability Facilitate family time at the bedside Ensure aftercare…